Neuro-ophthalmology

The optic nerve and the inner layers of the retina anatomically speaking are part of the central nervous system (CNS) and can be affected by a number of diseases that afflict the rest of the CNS. The eye and its surrounding tissues are served by no fewer than 6 of the 12 cranial nerves.

The boundaries of neuro-ophthalmology are not precisely defined and overlap with a number of ophthalmic sub-specialties and neurology. Some neuro-ophthalmologists develop an interest in this sub-specialty from specialty training in ophthalmology, while others may have trained as neurologists or medical ophthalmologists. Those with an ophthalmology background may also carry responsibility for strabismus and paediatric ophthalmology or uveitis in their unit.

The range of conditions presenting to neuro-ophthalmology services is diverse and typically includes cranial nerve pathology, giant cell arteritis and ophthalmic manifestations of other systemic vasculitides, ophthalmic manifestations of demyelination, ocular myopathies, brainstem disorders, idiopathic intracranial hypertension, pituitary disease and nystagmus.

Neuro-ophthalmology is largely a non-surgical specialty, though some neuro-ophthalmologists perform optic nerve sheath fenestration for patients with idiopathic intracranial hypertension that has failed to respond to other forms of treatment. Some neuro-ophthalmologists also undertake eye-muscle surgery for nystagmus.

Neuro-ophthalmologists maintain close working links with other specialties such as neurology, rheumatology, neuro-radiology and endocrinology.